Medicaid funding cuts put mentally ill at risk

Nearly 200 Sunnyside patients may go untreated

YAKIMA - The practice of serving those who can't afford mental health treatment could come to an end for the Central Washington Comprehensive Mental Health (CWCMH) agency.

For Sunnyside, that could mean that as many as 189 people will have to be cut off from services unless they are able to pay. CWCMH anticipates having to cut services, which includes medication to about 1,400 people.

New federal interpretations of Medicaid funding regulations will bring to an end service to clients who cannot afford care and do not have Medicaid. Clients cut off from services will range from young children to the elderly. According to Rick Weaver, CEO of Central Washington Comprehensive Mental Health, those to be removed from services will be teens and adults suffering from depression, children with ADD who are disruptive in class, as well as the severely mentally ill.

The new ruling will make it so that no Medicaid dollars can be spent on non-Medicaid clients or for non-Medicaid approved services.

Services under question are residential services, which is 24-hour care. Currently there are 25 people in full-time, residential care in Sunnyside. Weaver said Medicaid already refuses to pay for any residential services in Sunnyside. Comprehensive Mental Health picks up the bill for those serviced at the local office. He explained that residential care facilities operated by CWCMH keep clients from being institutionalized.

The new ruling comes after an 11-year history of federally approved uses of Medicaid monies for uninsured or under-insured non-Medicaid patients.

Weaver said that the CWCMH board has raised some funds, which will allow them to provide the most severely ill with services while funding is reviewed by the state legislature. He said the funds will only last a couple of months.

Weaver anticipates that slightly less than 1,400 clients without Medicaid will initially be dropped from services. The severely ill clients they continue to serve will be funded for a month or two through privately raised money until it runs out.

He explained that the Medicaid money is not being taken away from CWCMH, but rather it can't be used for non-Medicaid clients. The change, which takes effect Jan. 1, 2005, will also cut the sliding scale fee program, which assists clients with payment.

Clients cut from the services will still be able to call the 24-hour crisis system, said Weaver. He added that studies have shown that many of the mentally ill patients who are released into the community will end up in hospital emergency rooms or jail. He said that anticipating the Medicaid cut, they have been building a larger mental health emergency room to handle more patients coming in off the streets.

Weaver added that many who are in the residential programs do not have homes or cannot live on their own.

He said that they may have family who will take them in, but often family is unable to handle a mentally ill patient.

"What would happen is they would end up at the state hospital," said Weaver.

Weaver explained that there is a cap on how many mental health patients each county can have at the state hospital. Counties over their limit are charged a fee, he said.

"We're the model program in the state," said Weaver. "We're very successful at keeping people out of the state hospital."